Authors (including presenting author) :
Wong SN
Affiliation :
Department of Orthopaedics and Traumatology, Caritas Medical Centre
Introduction :
Kowloon West Cluster Orthopaedic Rehabilitation Centre (KWCORC) is the receiving facility to which the Orthopaedics patient in the cluster hospitals who need rehabilitation service can be referred. Before 2017, the referral process worked in the form of document faxed and telephone call between the initiating hospital and rehabilitation centre. Nurses in the KWCORC contributed in screening upon received referral, referencing referral criteria and feedback to the initiating hospital to ensure the right patient could receive the appropriate level of care. 2000 referrals from the cluster hospitals, of which around 200 were cancelled and 200 were rejected. Upon screening of these referrals, the nurse made multiple phone calls to initiating hospitals for clarification of missed data, illegible handwriting, etc., returned for correction which may waiting for 2 to 3 days. In 2016, there were around 1100 episodes of return received referrals. This time consuming process delayed the transfer of appropriate patients to rehab level of care, and created enormous workload to nurses which were preventable. Moreover, referral by fax induced 1) risks of patient data or information privacy loss during the transmission of the documents, 2) huge volume of paper waste which was not environmental friendly. Also, there was no open platform for the initiating hospitals to get direct access of patient queue status. To tackle these problems, a web-based transparent central booking referral system was developed and implemented in the year of 2017.
Objectives :
(1) To optimize the referral process with advance information technology. (2) To revise the content of electronic form for nurse to early establish patient rehabilitation and pre-discharge plan. (3) To provide a transparent platform for user access to the referral status.
Methodology :
Task group formation (1) To input in the design format and data setting of the web-based referral from nursing perspective (2) To review and monitor the workflow during implementation. (3) To collect data and opinions, and feedback to the task group for revision as indicated.
Result & Outcome :
A task group with doctors, nurses and HA ITD staffs was formed. An comprehensive and user-friendly web based referral system was formulated. Tick boxes were designed for patient-conditions items. Queuing sequence was added to increase transparency. In April 2017, live run of ORRS was first commenced in CMC, pitfalls were identified and resolved. It was promulgated to cluster hospitals in May 2017, and fully implemented in KWC in September 2017. Reviewed services in 2019, 1840 electronic referrals were received, ~1400 were accepted instantly; the cancelled and rejected ones were each accounted for around 160. Phone calls to referring hospitals were decreased to around 650 episodes(450 episodes less than 2016). In 2018 & 2019, over 75% of the e-referrals were screened and queuing < 3 hours after submission. In 2020, the percentage was increased to over 80%. This relative manpower saving enables nurse (1) to work with patients to design a tailored rehabilitation plan, (2) to educate patients for attaining and maintaining maximum function, (3) to coordinate nursing activities in collaboration with multidisciplinary team for enhancing high quality of patient care. The comprehensive web-based referral provides information for nurses to have early screen cases and early plan the rehabilitation program of patients. It also makes the queuing status be transparent to users of all hospitals. In conclusion, KWCORC referral process was streamlined with ORRS. It eradicates the risks of patient data privacy loss, improves the workflow and eliminate numerous administrative works of nurses. It fasten patient admission and enables nurses to formulate the rehabilitation program at time of receiving referrals. The system is open and transparent, and thus is a good communication platform for all referring hospitals. Lastly, it is environmental friendly to practice paperless management.
